Individuals’ positive gains from the COVID-19 pandemic: a qualitative study across 30 countries

The COVID-19 pandemic, an unprecedented global crisis, has indelibly reshaped all facets of life globally – health, economy, environment, and societal fabric [1–3]. Major societal events are often transformative. The predominant focus on the pandemic’s negative impacts, necessitates a more balanced perspective to prevent a skewed understanding of its overall impacts. Additionally, unveiling the hidden positive outcomes or unintended consequences is essential for developing well-rounded strategies that sustain these shifts and foster hope and resilience.

In this study, positive gains refer to the diverse range of beneficial outcomes that individuals experienced as a result of the COVID-19 pandemic. The premise that adversity can lead to positive outcomes is supported by several theoretical perspectives [4–6]. First, Post-Traumatic Growth theory suggests that adversity can foster personal growth and resilience [4]. Second, Social Cognitive Theory emphasises that individual factors and behavioural adaptations can catalyse broader societal changes, especially in public health and social norms [5]. Lastly, Collective Behavior and Social Movements theory highlights the pandemic’s potential to drive societal evolution and initiate new social movements [6]. These theories collectively underpin our expectation that, despite its challenges, the pandemic could yield positive developments.

Emerging literature, albeit limited, has begun to identify several positive outcomes of the pandemic, such as environmental benefits, strengthened relationships, new hobbies, improved hygiene, healthier lifestyles, and technological innovation [1,7–12]. However, these primarily quantitative studies have often been limited in scope, focusing on specific groups or regions. This leaves a gap in understanding the broader spectrum of the pandemic’s positive gains, especially across different global contexts.

In response to the research gap, this study adopts a qualitative approach, leveraging open-ended questions to capture diverse and rich personal positive experiences globally. Our study strives to offer a comprehensive perspective on the pandemic’s overlooked positive gains, informing policy and societal development strategies.

Methods

Methodological orientation

This study utilised an interpretative qualitative approach to identify themes in participant narratives about positive gains from the COVID-19 pandemic. This method was chosen for its direct insight derivation from qualitative data, aligning well with the study’s exploratory nature.

Participants and setting

In this cross-culture and cross-sectional study, we engaged individuals aged 18 and older from 30 countries using convenience sampling [13]. Data collection, spanning from July 2020 to August 2021and specifically targeting responses to the open-ended question, involved both digital methods (such as a dedicated survey website and social media) and traditional methods (offline surveys), thereby encompassing settings online and at various physical locations. Of 16 512 respondents, 2659 (16.1%) provided no response. The survey’s design indicates independent responses from participants in the absence of non-participants.

Data collection

In addition to completing demographic questions, participants were invited to share up to three positive outcomes they experienced during the COVID-19 pandemic. The instrument was an open-ended question: ‘What have you gained from the COVID-19 pandemic? Please list the top three gains.’

Translation and data preparation

A reputable translation company was engaged to translate all non-English responses into English, thereby ensuring accuracy. Their approach encompassed translation by expert linguists, a comprehensive quadruple-check quality control process (translator, editor, engineer, and linguistic for checking), and the integration of client feedback, guaranteeing both linguistic accuracy and contextual fidelity. The translated English versions then served as the basis for thematic analysis. As an online survey limitation, translated transcripts were not returned to participants for feedback or corrections.

Qualitative analysis

We used spreadsheets to analyse qualitative data, chosen based on the data type and participant responses [14]. An inductive thematic analysis following Braun and Clarke’s six-phase framework was applied, allowing themes to emerge naturally without predefined categories [15].

Coding process and coders

Primary coder JYL familiarised herself with the data by thoroughly reviewing all responses, identifying preliminary ideas and potential codes [15]. The coding process involved two primary coders: JYL and YQL. Specifically, JYL identified initial codes based on her thorough engagement with the data. To enhance reliability and minimise individual bias, YQL. checked whether the coding is acceptable of a random subset of 10% of the responses (3591 responses), balancing representativeness and manageability [14]. Discrepancies were resolved through discussions, with about 1.5% of responses requiring consensus.

To assess inter-rater reliability and account for YQL coding only a portion of responses, we utilised ChatGPT-4 as an auxiliary checker. We measured the inter-rater reliability between the primary coder (JYL) and ChatGPT-4 using percent agreement [16], considering ChatGPT-4’s coding was dependent on JYL’s initial classifications. Among 35 911 codings, we observed a 94.5% agreement rate, demonstrating strong concordance between the coders.

Theme development and thematic saturation

JYL grouped similar codes into subthemes using a constant comparison method [17] and then iteratively integrated these into broader themes aligned with the research questions. She continuously assessed the coherence among responses, codes, subthemes, and themes, making adjustments to ensure the themes were data-derived and accurately reflected participants’ experiences.

Thematic saturation was reached when no new themes or subthemes emerged from additional data, determined through continuous review and iterative coding [18]. Both coders identified saturation during the middle of the coding process, but continued coding all survey responses to facilitate quantitative comparison.

Defining and naming themes and producing report

After achieving thematic consistency, JYL precisely defined each theme and subtheme, aligning them with the research questions and supporting them with illustrative examples. Due to the online survey method, returning findings to participants for feedback was not feasible.

Research team and reflexivity

The first author (JYL) who led this study is a female researcher with experience in conducting qualitative research, focusing on the global impact of COVID-19 [1]. Her background provides a perspective on the pandemic’s multifaceted impacts. Prior to the commencement of this study, JYL had no established relationships with the participants, who were unaware of her research goals and motivations. Her research experience in global COVID-19 impacts ensures an objective and well-informed perspective.

Supplementary quantitative analysis

We further quantified our qualitative findings for cross-demographic, cross-country and regional comparisons. We first assessed the prevalence of ‘negative gains’, an unexpected outcome in our primarily ‘positive gains’ focused study. This involved calculating the proportion of negative responses in each group or region to gauge the extent of negative impacts and contextualise positive responses. Subsequently, we redefined ‘positive gains’ as our entire data set (100%) to analyse the proportion of each positive theme within all positive responses across different areas or groups. For regional comparisons, countries were categorised into six World Health Organization regions: African (AFR), European (EUR), South-East Asia (SEAR), Americas (AMR), Eastern Mediterranean (EMR), and Western Pacific (WPR). They were also classified by economic development levels into low-income countries (LICs), lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs), following the World Bank’s 2020 classification [1].

Ethics approval

The institutional review board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster approved this study, reference no: UW 20–272. This study obtained informed consent from all participants and ensured anonymity by not collecting identifiable personal information. All responses were anonymised and securely stored with restricted access. Participants were informed that participation was voluntary and could withdraw at any time if they feel emotional distress. These measures prioritised data security and participant well-being throughout the research process.

Results

Participants’ sociodemographics and geographical distribution

In our international sample of 16 512 adults, 13 853 participants provided at least one response. This group comprised 9214 young adults (66.5%), 3519 middle adults (25.4%), and 1120 older adults (8.1%). The gender distribution included 8827 females (63.7%), 4940 males (35.7%), and 86 non-binary individuals (0.6%). Table 1 provides additional socio-demographic details and geographical distribution. After cleaning data for all received responses, we obtained 35 911 valid responses for subsequent thematic analysis (Figure 1).

Table 1.  Sociodemographics, country, and region details of participants and their thematic responses distribution (n = 13 853)

*Theme 6: distrust and emerging vulnerabilities.

†Theme 1: improved health awareness and practices.

‡Theme 2: strengthened social bonds and trust.

§Theme 3: multi-dimensional personal growth.

¶Theme 4: resilience and preparedness building.

║Theme 5: accelerated digital transformation.

Figure 1.  Flowchart of data cleaning.

Qualitative findings

Thematic analysis yielded five main positive themes and an unexpected negative theme, 39 subthemes, and 673 codes emerged. The identified themes were:

1. improved health awareness and practices;
2. strengthened social bonds and trust;
3. multi-dimensional personal growth;
4. resilience and preparedness building;
5. accelerated digital transformation;
6. distrust and emerging vulnerabilities (this unexpected theme deviates from our main topic but was retained as it provides valuable insights).

Table 2 outlines the structure of themes and subthemes and representative quotations.

Table 2.  Overview of main themes, subthemes, and representative quotations

Improved health awareness and practices (Theme 1)

This theme describes the unexpected benefits of the COVID-19 pandemic on people’s health aspects worldwide. It highlights how the crisis has improved health awareness, knowledge, and habits at individual and environmental levels. At the individual level, people have become more health-conscious, prioritising well-being and learning about health risks (Table 2). Participants reported adopting improved hygiene and preventive health measures, along with healthier lifestyles that include more exercise and a healthy diet (Table 2). These changes also extend to personal spaces, as many become aware of and improve their home environments (Table 2). The pandemic has encouraged a slower pace of life, promoting self-renewal and overall health (Table 2). Additionally, while reducing environmental pollution, it has heightened awareness of the interconnectedness of health and the environment (Table 2). The perceived positive changes led to health improvements (Table 2), such as better sleep and weight loss. Overall, it reveals a significant shift in health consciousness and practices, leading to improved personal and environmental well-being during the pandemic.

Strengthened social bonds and trust (Theme 2)

This theme describes how the COVID-19 pandemic has positively intensified interpersonal connections, community cohesion, social accountability, and trust in societal systems. People have deepened bonds with family, friends, pets, and others (Table 2). Communities have seen a revival of altruism and civic engagement (Table 2). Trust in society, authorities, health systems, and governments has been renewed (Table 2). This theme emphasises the critical importance of social unity and shared responsibility in overcoming collective challenges and recognises these strengthened social ties as one of the pandemic’s positive outcomes.

Multi-dimensional personal growth (Theme 3)

Theme 3 describes the multifaceted personal growth triggered by the pandemic, spanning both tangible and intangible realms. The intangible dimension is marked by a profound emotional and philosophical realignment (Table 2), enhancing self-understanding and reshaping value systems. Concurrently, there was an increased emphasis on personal empowerment and autonomy, coupled with a shift towards simplicity and minimalism (Table 2). In the tangible domain, notable strides were made in time management and value-added activities (Table 2), facilitating both personal and professional enrichment. This is further reflected in significant academic and career progressions, and the adoption of new skills and hobbies, alongside mindful leisure pursuits (Table 2). Together, these interwoven intangible and tangible elements underscore a holistic evolution in personal development during an unprecedented global challenge.

Resilience and preparedness building (Theme 4)

This theme explores the transformative journey of adaptation and resilience propelled by the COVID-19 pandemic, emphasising evolution through adversity. It highlights a spectrum of psychological responses such as acceptance, coping, and resilience (Table 2). It reveals how individuals and communities adaptively responded, showing flexibility amid altered life routines, and effectively tackled various crises and challenges (Table 2). A proactive approach was also evident in financial management and employment adaptability, including job retention and exploring new opportunities (Table 2). The emphasis on planning and preparedness (Table 2) highlights a forward-thinking response to the crisis. The pandemic period also fostered significant learning and growth from the adversity (Table 2), signifying a transformative shift from adversity to resilient development. Governmental aid (Table 2) played a supporting role in this transformation. Overall, this theme captures not only the immediate handling of crises but also the extensive learning and preparation for future challenges.

Accelerated digital transformations (Theme 5)

Theme 5 emphasises the swift shift to digital platforms prompted by the COVID-19 pandemic. It intricately maps the expansion across various sectors: online learning’s surge (, the widespread adoption of remote work (, and the significant increase in digital literacy and skills (Table 2). The theme further explores the evolution of digital communication and social engagement, alongside the growth of online shopping and e-commerce (Table 2). Additionally, it highlights the emergence of remote health care (Table 2) as a new norm. This digital transformation illustrates how society swiftly embraced technology for education, work, commerce, and health care, showcasing technology’s critical role in ensuring continuity and flexibility.

Distrust and emerging vulnerabilities (Theme 6)

Theme 6, which emerged unexpectedly from the request for the description of positive changes, reflects the multitude of challenges unleashed by the COVID-19 pandemic and potentially the paradox of emotions This response reflects the physical and emotional aspects of the pandemic (Table 2). This period was marked by a notable decline in public trust, with increased scepticism towards societal systems and authorities, underscoring a deep-rooted distrust in institutions (Table 2). The crisis also brought about social instability, manifesting in financial stress, job market turbulence, daily life constraints, educational disruptions , and fundamental survival challenges (Table 2). This narrative emphasises the urgent need for comprehensive health policies to tackle these varied impacts and restore trust in the aftermath of the pandemic.

Quantitative findings

Globally, although our study initially targeted positive gains, we found that 12.0% (4304 out of 35 911) of responses reported negative gains, which fall under Theme 6. Table 2 displays the number of responses for 6 themes as well as their subthemes.

Demographics disparities

For positive gains, the percentage of responses decreased from Theme 1 (highest) to Theme 5 (lowest) consistently across all demographic groups (Figure S1 in the Online Supplementary Document). Conversely, individuals identifying as non-binary, with lower education levels, or facing employment challenges such as self-employment or layoffs, reported more proportion of negative gains (Theme 6) (Figure S1 in the Online Supplementary Document).

National level

At the national level, the distribution of responses under Theme 1 varied from 18.1% in Spain to 73.8% in Burundi. For Theme 2, the proportions ranged from 3.3% in Burundi to 36.8% in Chile, and for Theme 3, they spanned from 9.4% in Thailand to 36.2% in Spain. Responses in Theme 4 were reported between 6.9% in Indonesia and 27.5% in Thailand, while Theme 5 responses varied from 0% in Burundi to 8.6% in Thailand. Notably, Theme 6 (negative gains) was most prevalent in Burundi (94.1%), Rwanda (31.8%), and Canada (26.9%), with the lowest percentages in Guatemala (2%), Spain (2.8%), and Chile (2.9%). Additionally, the thematic dominance of positive gains varied across nations. 19 countries, including Australia, Burundi, Egypt, Hong Kong, India, Indonesia, Italy, Lebanon, Libya, Macau, Malaysia, Nigeria, Philippines, Republic of Sudan, Rwanda, Saudi Arabia, South Korea, Thailand, and Vietnam, primarily reported gains in Theme 1, with the proportions ranging from 31.7% in Italy to 73.8% in Burundi. Canada, Chile, China, Singapore, and the United States reported primarily Theme 2 gains, with a range from 29.2% in Brazil to 36.8% in Chile. Theme 3 gains were notably prevalent in Brazil, Guatemala, Mexico, South Africa, Spain, and the UK, with proportions between 29.6% in South Africa and 36.2% in Spain. Notably, no countries reported predominant gains in Themes 4 and 5 (Figure 2).

Figure 2.  Proportional distribution of negative to all responses and positive by theme to all positive, by country (n = 35 911).

Regional level

At the regional level, the distribution of responses for Themes 1 to 5 showed a range of proportions: 21.7% in the AMR to 45.6% in SEAR for Theme 1, 14.9% in AFR to 30.5% in AMR for Theme 2, 14.1% in SEAR to 29.3% in AMR for Theme 3, 9.5% in the WPR to 17.3% in SEAR for Theme 4, and 3.1% in WPR to 6.3% in SEAR for Theme 5. AFR recorded the highest proportion of negative gains (37.7%), while the EMR had the lowest (7.4%). In terms of positive gains, the AMR predominantly reported Theme 2 gains (30.5%), whereas EUR had a higher proportion of Theme 3 gains (28.4%). AFR, EMR, SEAR, and WPR regions primarily observed Theme 1 gains, with proportions ranging from 38.0% to 45.6% (Figure S2 in the Online Supplementary Document).

Economic development levels

At different economic development levels, responses for Themes 1 to 5 varied: from 33.6% in UMICs to 44.9% in LICs for Theme 1, from 13.7% in LMICs to 25% in HICs for Theme 2, from 20.3% in HICs to 25.2% in LICs for Theme 3, from 10.1% in HICs to 14% in UMICs for Theme 4, and from 3.4% in LICs to 4.8% in UMICs for Theme 5. The LICs exhibited the highest proportion of negative gains (43.9%), while the LMICs reported the lowest (7.5%). Across all economic levels, Theme 1 was predominant, with proportions ranging from 33.6 to 44.9% (Figure S2 in the Online Supplementary Document).

Discussion

In this qualitative study analysing 35 911 responses from 13 853 diverse international participants regarding their positive gains from the pandemic, we identified five positive gains from the COVID-19 pandemic (ranking from biggest to smallest response percentage): improved health awareness and practices, strengthened social bonds and trust, multi-dimensional personal growth, resilience and preparedness building, and accelerated digital transformation. The ranking reflects each theme’s relative frequency and importance, enabling us to contextualise the qualitative findings by identifying the most and least prevalent gains. This allows policymakers and practitioners to prioritise high-impact initiatives and allocate resources effectively, while stakeholders can develop targeted strategies to reinforce strengths and address specific participant needs. These themes were consistently observed across demographics, with regional and cross-country variations: AMR focusing on social cohesion, EUR on personal development, and other regions on enhanced holistic health. Notably, 19 countries reported more gains in enhanced holistic health, five countries on strengthened social cohesion, and six on multi-dimensional personal development. A contrasting and unexpected theme of negative experiences, especially distrust and vulnerabilities, was more pronounced in countries like Burundi, Rwanda, and Canada, as well as African and low-income regions, significantly affecting non-binary individuals, those with lower education, and those facing employment barriers.

The pandemic has significantly increased health awareness and practices, surpassing previous expectations [19], and offers health care providers a chance to incorporate these into long-term plans. Quantitative analysis revealed that increased health knowledge, awareness, and practices were the most significant positive gains within this theme, requiring the highest attention. Public health campaigns should prioritise ongoing health awareness and hygiene practices to boost overall health and prepare for future crises by embedding pandemic-era habits – such as regular handwashing, mask-wearing during flu seasons, and improved sanitation protocols – into daily routines. This can be achieved through sustained educational programmes in schools and workplaces, reinforcing these practices within society. Additionally, health behaviour adaptations and lifestyle changes emerged as the second dominant subtheme. Reducing sugary drinks and increasing physical activity were key lifestyles [20,21], suggesting these areas should receive more support for holistic health improvements. Support measures might include taxing sugary beverages and developing public spaces that encourage physical activity, like parks and recreational centers. Moreover, health care systems are encouraged to advocate for a slower pace of life, emphasising rest and restoration, and promote work-life balance through policies such as paid mental health days, flexible working hours, and expanded telemedicine services. Increased environmental awareness presents an opportunity to promote eco-friendly habits and nature activities for better health. To translate environmental lessons into lasting behaviours, governments should invest in green urban spaces, support car-free zones, and implement community-based environmental programmes that encourage sustainable living. Public awareness campaigns should highlight the health benefits of reducing pollution and fostering a closer connection with nature, effectively transforming temporary pandemic gains into enduring societal changes that promote a healthier and more resilient society.

Strengthened social bonds and trust, beyond personal connections [11,22], offer health care systems an opportunity to develop lasting community resilience and health models, with strengthened relationships as the dominant subtheme. To leverage this, policies should support community-based health programmes, strengthen local networks, and create platforms for sharing experiences and health tips. The other two sub-theme are less dominant but still provide insights into an individual’s increased community responsibility and commitment as well as trust in authority, that can be leveraged for long-term benefits. Involving communities in health planning fosters active participation and civic engagement, which can be sustained by establishing community health committees or advisory boards that give residents a voice in health care decisions. Greater trust in health authorities can enhance guideline adherence and information sharing; thus, governments must maintain transparent, consistent communication strategies post-pandemic, including regular public health updates, open forums, and involving local leaders. This period of social solidarity provides a prime opportunity for collaborative health initiatives, like health ambassador programmes and mutual aid [23,24], encouraging shared health responsibility. To build on this, governments should institutionalise collaborative models, such as national health ambassador programmes, and encourage partnerships between businesses, civic organisations, and public health agencies to create a sustainable shared responsibility model.

Multi-dimensional personal growth, extending beyond previously reported self-organisation and hobbies [11,25,26], opens ways for adjustments in health and mental wellness initiatives. Quantitative analysis shows an even distribution among subthemes, suggesting balanced focus areas. Healthcare providers should design interventions that address both physical well-being and foster emotional intelligence and self-awareness. Programmes can include strategies for aligning personal values with health behaviours, such as mindfulness practices and value-driven goal-setting, promoting meaningful life changes. For instance, clinicians can help patients redefine their priorities in life, emphasising the importance of mental well-being and encouraging lifestyle adjustments that reflect personal values. Mental health services should adopt strategies that support emotional and philosophical realignment, aiding in self-understanding and resilience. Healthcare systems can utilise this shift towards empowerment and autonomy to foster patient-centred care, involving patients in their health decisions. Health programmes addressing tangible personal growth, like time management and skill acquisition, can promote a balanced lifestyle, integrating professional and personal well-being. Educational efforts in health care could emphasise skills and hobbies, such as yoga, for overall well-being and life satisfaction.

Amidst the pandemic’s extensive losses [27], society has cultivated widespread resilience and preparedness building. Acceptance, coping, and resilience, along with financial dynamics and management, were the two dominant subthemes. Healthcare systems can harness this by offering programmes focused on coping strategies and positive psychology, thereby sustaining and enhancing these developments and preparing communities for future challenges. Health education should emphasise crisis management, emergency preparedness, and life strategy planning to seize their forward-thinking mindset. To ensure lasting preparedness, public health campaigns should teach practical crisis management and proactive planning skills, including financial literacy, disaster preparedness, and mental resilience through schools, community workshops, and workplace training. Governmental aid in crises can further reinforce societal resilience by establishing robust support systems and emergency funds. These initiatives can solidify the behavioural advancements into long-term societal resilience.

Expanding on previous localised or group-specific digital transformation research [28–30], our study further validates these benefits. Online learning is the primary aspect of digital transformation, necessitating blending digital health education into curricula or training to ensure digital equity. Educational systems should teach digital skills early, emphasising not only basic technology use but also critical thinking, digital safety, and online communication. Remote work is the second major facet, requiring enhancements in telehealth and addressing remote workers’ health issues, such as ergonomics and eye strain. Policymakers should implement workplace wellness guidelines targeting these risks, including ergonomic training and mental health resources. Employers can adopt hybrid models with flexible arrangements and provide resources for mental and physical well-being, such as virtual ergonomic consultations or mindfulness workshops [31]. Other subthemes vary in the extent of transformation. Growing digital literacy and increased digital communication are paving the way for advanced digital health tools, including mental health platforms, telemedicine services, and mobile health apps. Governments and health organisations should invest in creating user-friendly, evidence-based digital health tools for widespread adoption. For example, developing accessible mental health apps with personalised support can expand care access, especially in remote or underserved areas. The rise in e-commerce suggests digital channels for health products and services. Health systems can partner with e-commerce platforms to deliver medical supplies, over-the-counter medications, and wellness products directly to consumers. Additionally, health care providers should implement telemedicine for routine check-ups, prescription refills, and consultations, reducing the need for in-person visits. Overall, this digital transformation highlights the necessity for health systems to adapt by providing flexible, technology-enhanced services and policies aligned with the digital age. Governments should support digital infrastructure development, particularly in rural or underserved regions, to ensure universal access to these services.

While our study primarily focused on positive outcomes from the COVID-19 pandemic, some participants reported negative gains, which we retained for their valuable insights. The proportion of negative gains indicates the extent to which regions or groups benefited from the pandemic. Areas with high negative responses, like Burundi (94.1%), may have missed opportunities for positive advancements, suggesting a need to prioritise recovery strategies over positive transformation. In regions dominated by negative gains, the focus should shift to addressing vulnerabilities and facilitating recovery. Beyond previous findings [1,32–34], our findings highlight the emergence of new vulnerabilities and a decline in public trust as key negative themes. Emotional challenges were the most dominant subtheme, followed by unmet basic needs and distrust in authorities. Given the compounded physical and emotional hardships, continuous care is essential. To tackle these issues, health care systems should implement community-based health and wellness programmes focused on mental health recovery and providing ongoing physical care, especially in trauma-affected regions. Rebuilding public trust requires transparent health care decision-making and effective communication strategies, including involving trusted community leaders and creating participatory platforms for public engagement. Additionally, providing affordable health care options, including regionally accepted traditional medicine, can alleviate financial burdens. Addressing unmet basic needs such as food insecurity, poverty, theft, and crime necessitates community-centred programmes that offer financial support, job training, and access to social services.

Quantitative analysis reveals thematic variations across regions, countries, and demographics, necessitating customised health strategies. In low- and middle-income areas such as AFR, EMR, SEAR, WPR, and 19 countries including Indonesia with underdeveloped health infrastructures [35]. The COVID-19 pandemic heightened health practices, leading to substantial improvements in health awareness and practices, resulting in the highest response percentage in the enhanced holistic health theme. In these contexts, health policies that specifically target holistic health could maximise health outcomes. In the AMR region and countries such as Chile, where individualism is prioritised [36], increased family time during pandemic-induced social distancing led to significant responses in the enhanced social cohesion theme, suggesting that community-focused health initiatives would be particularly effective. Similarly, in EUR and nations like Spain, the emphasis on personal development-backed by rich history, linguistic diversity, and cultural traditions in arts and philosophy-facilitates positive health transformations. This results in high responses for multi-dimensional personal growth, indicating that policies promoting individual health development could be particularly effective. Thailand’s achievements in digital and resilience areas highlight the value of enhancing these strengths [37], whereas Burundi’s digital gaps-evidenced by zero responses in this theme-are due to limited internet access, low digital literacy, economic constraints, and political and regulatory challenges [38,39]. Addressing these gaps requires investing in internet infrastructure, implementing digital literacy programmes, providing economic support for digital investments, and developing supportive policies and regulations.

Limitations and future research

Several limitations should be noted. First, while convenience sampling allowed us to collect data from a diverse range of participants across 30 countries, it has led to overrepresentation of certain demographic groups and regions, especially the young and female participants, as well as a limited number of respondents from low-income countries. This demographic skew may have biased the thematic distribution, potentially limiting the generalisability of our findings and highlighting the need for more balanced sampling methods in future studies. Second, we have not yet formulated a strategy to leverage the positive outcomes towards building a more sustainable and resilient society. Future research should explore methods to capitalise on these benefits for societal betterment. It should aim at identifying specific strategies and interventions that can transform these gains into actionable policies and support for communities. Third, this study was specifically designed to focus on positive gains from the COVID-19 pandemic. Although negative gains emerged unexpectedly and were retained due to their valuable insights, the survey was not structured to systematically capture negative outcomes. Consequently, the ratio between positive and negative gains does not reflect their true prevalence or significance and should not be interpreted as indicative of their relative importance. Fourth, while this study integrates quantitative methods to enable straightforward comparisons between regions and demographic groups, facilitating more accessible and actionable policy guidance, using ‘percentage of responses’ in thematic analysis may oversimplify qualitative data and introduce potential biases, particularly in regions with small sample sizes. Fifth, relying on a single open-ended question may have limited the depth of responses and overlooked key aspects of participants’ experiences. Future research should use more comprehensive qualitative methods, such as interviews or focus groups. Sixth, this study does not account for the complex cultural and political factors that may influence thematic variations, as these elements are multi-dimensional and data availability is limited, thereby constraining the depth of our comparative analysis.

CONCLUSIONS

In summary, this study reveals the COVID-19 pandemic’s varied positive gains, including enhanced holistic health, strengthened social cohesion, multidimensional personal growth, increased resilience and adaptation, and significant digital shifts. These findings offer a balanced view of the pandemic’s impact and provide insights to inform future health policies aimed at making these pandemic-induced positive shifts more sustainable, healthier, and resilient. Additionally, the emergence of an unexpected ‘negative gains’ theme, which highlights social instability, new vulnerabilities, and distrust, warrants targeted interventions for recovery. Notably, the variation in thematic responses across demographics, countries, and regions reflects both the ability to harness positive changes and the severity of negative impacts, necessitating tailored health strategies. Future research should focus on longitudinal studies to assess the sustainability of these positive changes over time and comparative studies across diverse cultural contexts to understand how cultural, economic, and health care system factors influence these gains. Additionally, employing mixed-methods approaches and targeting underrepresented populations will ensure a more comprehensive and inclusive understanding of the pandemic’s impact.

Additional material

Online Supplementary Document

Acknowledgements

We would like to thank Miss Bobo Chan for her tremendous administrative support of the project.

Ethics statement: This study was approved by the Institutional Review Board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster (reference no: UW 20-272). Informed consent was obtained from all participants, ensuring they were aware of the study’s purpose, data collection methods, and their rights. To protect data privacy and handle sensitive health information confidentially, all participants completed the survey anonymously, and data storage and analysis were conducted in strict compliance with the Declaration of Helsinki, upholding the highest standards of data security and confidentiality.

Data availability: Data are available upon reasonable request from the corresponding author.